In-depth articles

Background

British history

Occasionally in the history of medicine, a single
medical journal article will have a dramatic impact on medical practice.
Such was the case with a paper by Douglas Gairdner, which appeared
in the British Medical Journal in 1949 [Br Med J.
1949; 2:1433-1437]. Shortly following its publication, the British
National Health Service discontinued funding routine infant male
circumcision, and the circumcision rate fell quickly. By 1972, the
infant circumcision rate in Britain was less than one-half of 1
percent [Edward Wallerstein, Circumcision: An American Health
Fallacy. Springer, New York, 1980, p. 28-30].

American history

The history of circumcision in the United States has been
extensively researched by medical historian David Gollaher [J.
Social History 1994; 28:5-36].

Abstract: Neonatal circumcision, a ritual
older than history, first entered American clinical medicine in
the 1870s through the work of Lewis Sayre, a prominent orthopedic
surgeon and president of the American Medical Association. Based
on reflex theory, Sayre used the procedure for paralysis and even
for mental disorders. Other doctors believed it could prevent cancer,
inhibit the spread of syphilis, and deter masturbation, thought
to cause insanity. During the 1880s and 90s, physicians began to
use it on infants as a preventive operation. Meanwhile, in a period
of massive immigration and new concerns about hygiene, circumcision
became a mark of social class - of having been delivered in a hospital
by a regular physician. Circumcision persisted, despite there being
no scientific evidence of its efficacy, because physicians and patients
continued to reinforce its social meaning long after the original
theories that inspired it were discredited.

Sexual function

As currently performed in the United States, circumcision
removes a large fraction of the penile skin system. The tissue which
is removed, commonly known as the foreskin, has a number of sexual
functions, including the following:

The foreskin is erogenous tissue, containing an enormous number
of nerve endings which contribute to the sexual response of the
penis.

The foreskin protects the sensitive glans. The glans of a circumcised
man loses much of its sensitivity from constant exposure to clothing.

When retracted, the foreskin provides loose skin on the shaft
of the penis, which facilitates sexual intercourse.